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Biomedical subjects

I Laufer

Publications and source records attributed to I Laufer.

At least 19 recordsLinked to original sources
PubMed1992

Focal spiculation of the upper thoracic esophagus: normal variant at double-contrast esophagography.

A review of 100 routine biphasic upper gastrointestinal examinations revealed focal spiculation of the upper thoracic esophagus as a transient finding in 11 patients (11%) who otherwise had no clinical or radiographic signs of esophageal disease. All 11 patients had remarkably similar findings, with thin (1-2 mm wide), transverse folds or striations above the level of the aortic arch, producing a spiculated or serrated appearance in profile. This focal spiculation should be considered a normal variant in the esophagus on double-contrast radiographs. It is suspected that this phenomenon is related to weakening of peristalsis or localized contraction of the longitudinally oriented muscularis mucosae at the junction of the striated- and smooth-muscle portions of the esophagus. Whatever the explanation, radiologists should be familiar with this finding, so that it is not mistaken for a focal area of esophagitis.

Adolescent↗
PubMed1992

Optimizing gallbladder stone lithotripsy: an international survey.

Rates of stone clearance with extracorporeal shock wave cholecystolithotripsy (biliary lithotripsy [BL]) initially reported by European groups were encouraging. An American multicenter BL study (the Dornier National Biliary Lithotripsy Study [DNBLS]) did not reproduce these results. The BL treatment strategies and 6-month stone clearance rates of six leading European and Japanese centers were compared with those of DNBLS. All foreign centers used adjuvant oral chemolitholysis and greater shock wave energies from the same lithotriptor as that in DNBLS. Six months after BL, the stone clearance rates at all six centers were higher than those of DNBLS. There were no significant differences in complication rates between centers. These findings suggest that the poor results of DNBLS were chiefly due to the use of low kilovoltage and few BL sessions. Increased energy levels and a fragment size end point of less than 5 mm optimize BL. Despite the popularity of laparoscopic cholecystectomy, BL can be recognized as a successful treatment alternative for patients with a low burden of radiolucent stones.

Cholelithiasis↗
PubMed1991

Pictorial review: principles of double-contrast pharyngography.

This pictorial essay will explain how to obtain quality double- contrast radiographs during pharyngography, present principles of the interpretation of double-contrast images of the pharynx, and show examples of benign and malignant pharyngeal tumors.

Adult↗
PubMed1991

Oral cholecystography in contemporary gallstone imaging: a review.

The introduction of nonoperative alternatives to elective cholecystectomy in the management of gallstones has resurrected use of oral cholecystography (OCG). This article reviews basic principles involved in the proper performance of OCG and interpretation of the resulting images. The role of OCG in the current management of gallstones is discussed.

Bile↗
PubMed1991

Giant, human immunodeficiency virus-related ulcers in the esophagus.

Human immunodeficiency virus (HIV) infection of the esophagus has recently been implicated as a cause of giant esophageal ulcers in HIV-positive patients with odynophagia. The authors examined four patients in whom esophagograms (one single-contrast and three double-contrast studies) revealed giant, HIV-related ulcers indistinguishable from those of cytomegalovirus (CMV) esophagitis. All four patients had severe odynophagia, one had an associated maculopapular rash, and two became HIV-positive at approximately the time of clinical presentation. In all patients, biopsy samples, brushings, and cultures obtained with endoscopy were negative for CMV or herpes simplex. One patient had positive brushings for candidiasis, but this may have resulted from fungal superinfection of the ulcer. Two patients were treated with orally administered steroids, and all four had swift clinical improvement; symptoms disappeared during an average period of 8.3 days from presentation. HIV-related esophageal ulcers should be distinguished from CMV ulcers, so that appropriate treatment can be initiated in these patients.

Adult↗
PubMed1991

Diagnosis of pneumoperitoneum on supine abdominal radiographs.

A blinded, retrospective study was performed to determine the value of supine abdominal radiographs in diagnosing pneumoperitoneum. Supine films from 44 cases of pneumoperitoneum were randomly interspersed among supine films from 87 control subjects without free air, and the films were reviewed for the presence or absence of various signs of pneumoperitoneum, including Rigler's sign (gas on both sides of the bowel wall), the falciform ligament sign (gas outlining the falciform ligament), the football sign (gas outlining the peritoneal cavity), the inverted-V sign (gas outlining the medial umbilical folds), and the right-upper-quadrant gas sign (localized gas in the right upper quadrant). One or more of these signs were present in 26 cases (59%) of pneumoperitoneum, including the right-upper-quadrant gas sign in 18 cases (41%), Rigler's sign in 14 cases (32%), and the falciform ligament and football signs in one case each (2%). Unfortunately, there were frequent errors in the interpretation of the right-upper-quadrant gas sign and Rigler's sign, with a total of 11 false-positive cases (13%). Further analysis of the true-positive right-upper-quadrant gas signs showed that these gas collections were always triangular or linear with an inferolateral to superomedial orientation and, if triangular, a concave superolateral border. In the true-positive Rigler's signs, the bowel wall thickness ranged from 1 to 8 mm, whereas the false positives all had a bowel wall thickness of 1 mm or less. Proper interpretation of the various signs of pneumoperitoneum on supine films should lead to more accurate diagnosis of this condition.

False Positive Reactions↗
PubMed1991

Complications after total gastrectomy and esophagojejunostomy: radiologic evaluation.

Total gastrectomy and esophagojejunostomy is an increasingly common operation that is associated with a variety of early and late postoperative complications. Between 1980 and 1990, 26 patients at our hospital who underwent this surgery (19 Roux-en-Y esophagojejunostomies and seven loop esophagojejunostomies) had postoperative upper gastrointestinal studies with water-soluble contrast material or barium. The studies were performed during the early postoperative period (within 30 days after surgery) in seven patients, the late postoperative period (more than 30 days after surgery) in seven patients, or both in 12 patients. Five patients (19%) had anastomotic leaks, four involving the esophagojejunal anastomosis and one the blind-ending jejunal limb. Five patients (19%) had transient narrowing of the esophagojejunal anastomosis during the early postoperative period, probably due to acute postoperative edema and spasm. Six patients (23%) had narrowing of the esophagojejunal anastomosis during the late postoperative period due to anastomotic strictures (three patients) or recurrent tumor (three patients). Alkaline reflux esophagitis was found in three (43%) of seven patients who had a loop esophagojejunostomy. However, two (11%) of 19 patients with a Roux-en-Y esophagojejunostomy had relatively long strictures in the distal esophagus, apparently due to scarring from alkaline reflux esophagitis. Two patients (8%) had an afferent loop obstruction due to metastatic tumor and postsurgical scarring. Radiologists need to be familiar with the normal postoperative radiologic appearances and the radiologic findings of early and late complications associated with this procedure.

Adult↗
PubMed1991

Diagnosis and imaging of gastrointestinal tract cancers.

Recent trends in the diagnosis and imaging of cancers of the gastrointestinal tract include developments in screening for colorectal cancer and innovations in ultrasonography and magnetic resonance imaging of primary and metastatic hepatic tumors. Mathematical models suggest that screening for colorectal cancer will be as cost-effective as several other widely accepted screening programs, including the Papanicolaou smear for cervical cancer and screening mammography. There is considerable discussion regarding the relative roles of procedures such as fecal occult blood testing, sigmoidoscopy, colonoscopy, and radiology in screening strategies. The issue remains unsettled. In ultrasonography, the use of intraoperative ultrasound allows for the detection of more metastatic lesions in the liver than do preoperative computed tomography and ultrasound. Esophageal endoscopic ultrasonography has been used for the preoperative assessment of depth of invasion by esophageal cancer. The technique is limited in cases of stenotic cancer in which the endoscope cannot be passed through the lesion. Similarly, endorectal ultrasound can be used for staging of rectal cancer. Color Doppler ultrasound has been used for the evaluation of blood flow in relationship to hepatic neoplasms. Magnetic resonance imaging has been used not only for detecting liver tumors but also for differentiating between neoplasm and hemangioma.

Diagnostic Imaging↗
PubMed1990

Nonvisualized gallbladder on oral cholecystography: implications for lithotripsy.

Currently, most protocols evaluating the efficacy of gallstone lithotripsy require a visualized gallbladder on oral cholecystography (OCG). The primary purpose of the OCG is to establish that the cystic duct is patent. When the gallbladder is visualized on OCG, it can also be used to number and size gallstones accurately. Patients with non-visualization of the gallbladder on OCG are excluded from consideration for lithotripsy. The purpose of this study was to evaluate retrospectively the ultrasonographic findings (i.e., number and sizes of stones in 32 patients with nonvisualization on the OCG). In 11 patients (34%) ultrasound (US) did not detect any stone, and it is presumed that the gallbladder failed to visualize for other reasons. Six patients (19%) had one or two stones and 15 (47%) patients had more than three stones. This suggests that 20% of patients with nonvisualization of the gallbladder on OCG would otherwise be eligible for lithotripsy provided that patency of the cystic duct can be demonstrated by other means, such as computed tomographic (CT) examination with oral biliary contrast or cholescintigraphy.

Cholecystography↗
PubMed1990

Isolated gastric varices: splenic vein obstruction or portal hypertension?

The presence of isolated gastric varices without esophageal varices is thought to be highly suggestive of splenic vein obstruction. A review of our radiologic files revealed 14 patients with isolated gastric varices on barium studies performed during the past 10 years. Eight of the 14 patients had adequate clinical and/or radiologic follow-up to suggest the pathophysiology of the varices. Seven had evidence of portal hypertension, and the remaining patient had evidence of splenic vein obstruction. Six patients had signs of upper gastrointestinal (GI) bleeding. Double-contrast upper GI examinations revealed thickened, tortuous fundal folds in 6 patients and a lobulated fundal mass in 2. Thus, most patients with isolated gastric varices have portal hypertension rather than splenic vein obstruction as the underlying cause.

Diagnosis, Differential↗
PubMed1990

Non-Hodgkin lymphoma of the small intestine.

The authors present a simplified radiographic classification of non-Hodgkin lymphoma involving the small intestine. The classification system is based on radiographic findings in 22 pathologically proved cases of lymphoma involving the small bowel and consists of three major forms: primary, lymphoma complicating celiac disease, and mesenteric nodal. In this series, small bowel lymphoma was evenly distributed in the jejunum and ileum. The most common radiographic patterns were circumferential lesion (seven cases), cavitary lesion (four cases), and mesenteric nodal disease invading the small bowel (seven cases). Obstructive symptoms were usually encountered with the mesenteric nodal form. Lymphoma complicating celiac disease was typified by multiple, thickened, nodular folds involving a segment of proximal small intestine.

Adult↗
PubMed1990

Scirrhous carcinoma of the stomach: radiologic and endoscopic diagnosis.

During a recent 10-year period, scirrhous tumors of the stomach were diagnosed at upper gastrointestinal examinations in 27 patients in whom pathologic correlation was available. Nineteen patients underwent double-contrast studies, and eight underwent single-contrast studies. Twenty-two of the 27 patients had primary gastric carcinoma, four had gastric involvement by metastatic breast cancer, and one had antral gastritis and scarring without evidence of malignancy. Although the involved gastric segment often demonstrated only mild loss of distensibility, the presence of a scirrhous tumor was suggested radiographically by distortion of the normal surface pattern of the stomach with mucosal nodularity, spiculation, ulceration, and/or thickened, irregular folds. Ten patients had localized lesions involving the gastric fundus and/or body rather than the classic form of linitis plastica involving the distal stomach. Furthermore, endoscopy had significant limitations in confirming this diagnosis, as findings from brushings or biopsies were positive for malignancy in only 14 of 20 patients (70%). Radiologists should be aware of the frequent proximal location of these scirrhous tumors and of the problems of endoscopic diagnosis.

Adenocarcinoma, Scirrhous↗
PubMed1990

Intact stones or fragments? Potential pitfalls in the imaging of patients after biliary extracorporeal shock wave lithotripsy.

Ultrasound is used after extracorporeal shock wave lithotripsy of gallbladder stones to assess fragmentation. In many patients with apparently successful fragmentation, the posttreatment studies show an intraluminal, echogenic focus within the gallbladder, with posterior acoustic shadowing characteristic of an intact stone. Cholesterol gallstones were fragmented in vitro by means of lithotripsy, and the sonographic appearance of the fragmented stones was followed up over time to study factors that might affect the process. After lithotripsy, fragments settled and produced an echogenic focus with posterior shadowing indistinguishable from the appearance of an intact stone. These experimental observations led to the development of a clinical maneuver to overcome the diagnostic pitfalls posed by the reaggregation of stone fragments in situ. This rollover maneuver helps distinguish between intact stones and fragments, and prevents both diagnostic errors in follow-up and unnecessary retreatment.

Cholelithiasis↗